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Passive Tissues Help the Back Muscles to Generate Extensor Moments During Lifting

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Passive Tissues Help the Back Muscles to Generate Extensor Moments During Lifting Pergamon J. Biomechanics, Vol. 27, No. 8, pp. 1077-1085, 1994 Copyright0 1994 Elwier Scicncc Ltd Printed in Gsat Britain. All rights reserved 002-9290/94 s7.cm+.txl 0021-9290(93)EOO12-E PASSIVE TISSUES HELP THE BACK MUSCLES TO GENERATE EXTENSOR MOMENTS DURING LIFTING P. DOLAN, A. F. MANNION and M. A. ADAMS Comparative Orthopaedic Research Unit, University of Bristol, U.K. Abstract-We examined the possibility that passive tissues can help the erector spinae to generate large extensor moments during lifting. One hundred and forty-nine healthy men and women participated in the study. Subjects pulled upwards with steadily increasing force on a floor-mounted load cell, while EMG activity was recorded from electrodes overlying the erector spinae at L3 and TlO. Extensor moment was calculated from the load cell data, and was plotted against the full-wave rectified and averaged EMG signal. The relationship was linear with an intercept on the extensor moment axis (I) which indicated the flexion moment resisted by ‘passive (electrically silent) tissues. The dependence of I on lumbar flexion angle was studied by repeating the isometric pulls between 6 and 12 times, with the subject positioned in varying amounts of flexion, as measured by the ‘3-Space Isotrak’. Subjects then lifted weights of up to 20 kg from the floor, using ‘stoop’, ‘squat’ and ‘freestyle’ techniques, while lumbar flexion and EMG activity were recorded at 28 Hz. The isometric pulls showed that, on average, I increased from 25 Nm in lordotic postures to 120 Nm (for men) and 77 Nm (for women), in full flexion. During the lifts, peak extensor moment was generated with the lumbar spine flexed by 78-97% of the range between erect standing and full flexion. Comparisons with the static calibrations showed that between 16 and 31% of the peak extensor moment generated during lifting was unrelated to EMG activity in the erector spinae. Comparisons with cadaveric data suggested that less than a quarter of this ‘passive’ extensor moment was due to the intervertebral discs and ligaments. INTRODUCTION the lumbar extensor muscles alone (McNeil1 et al., 1980). The thoracic erector spinae can generate an In stooped postures, the electrical activity of the extensor moment about the lumbar spine by means of erector spinae muscles falls to zero leaving the forward long tendons lying just underneath the lumbo-dorsal bending moment of the upper body to be resisted fascia (Bogduk et al., 1992; McGill and Norman, 1987) entirely by passive (electrically silent) structures. This but even so, there is barely enough active extensor ‘flexion-relaxation’ phenomenon depends on lumbar strength in the muscles (McGill et al., 1988). flexion rather than the overall angle of the trunk It appears likely that the muscles do receive assist- (Andersson et al., 1976; Floyd and Silver, 1955; Kip- ance from passive tissues, and the extent and origin of pers and Parker, 1984) and it can persist even when this assistance is of practical importance. If a sub- substantial weights are held in the hands (Floyd and stantial extensor moment is supplied by a structure Silver, 1955; Kippers and Parker, 1984; Schultz et al., lying just underneath the skin (for example, the lum- 1985). The origin of the ‘passive’ extensor moment is bo-dorsal fascia) then that structure has the advantage unknown, but it may involve the intervertebral disc ofa long lever arm about the ‘pivot’in the centre of the and ligaments, the iliolumbar ligaments, the lumbo- disc (Pearcy and Bogduk, 1988) and the spine will be dorsal fascia, collagenous tissue within the muscles subjected to a smaller compressive force than if the themselves, and a raised intra-abdominal pressure. same extensor moment had come from the muscles. The ‘passive’ moment may also involve remote mus- Similarly, a substantial extensor moment from the cles pulling actively on these structures. intervertebral ligaments would have a high ‘cost’ in Whatever its origin, a passive extensor moment has terms of lumbar compression because they lie closer to the potential to assist the muscles of the lumbar spine the pivot than the muscles. Therefore, calculations of during manual handling. When heavy weights are spinal compression during manual handling are re- lifted from the ground, the lumbar spine must generate liant on accurate information concerning the origins a high extensor moment in order to raise the upper of the extensor moment. body and weight into the upright position. Calcu- Another reason for wanting to apportion the exten- lations based on muscle cross-sectional area suggest sor moment between active and passive tissues is the that the required forces are beyond the capability of likelihood that they will respond differently to repeti- tive or chronic loading: metabolically active muscle will fatigue (Roy et al., 1989) and passive tissues will ‘creep’ (McGill and Brown, 1992). The highest risk Accepted in final form 16 September 1993. Address correspondence to: Dr P. Dolan, Comparative factor so far reported for acute disc prolapse is frequent Orthopaedic Research Unit, Department of Anatomy, Uni- bending and lifting (Kelsey et al., 1984) but the mech- versity of Bristol, Park Row, Bristol BSl 5LS, U.K. anisms leading to this association cannot be satis- 1077 1078 P. DOLANet al. factorily explored until the role of active and passive bodymass, height, mobility, and strength in lifting (see tissues in lifting tasks is better understood. below). Gracovetsky and Farfan have suggested several mechanisms which might lead to extensor moment generation from the lumbo-dorsal fascia (Gracovetsky A simple analysis of moments and Farfan, 1986; Gracovetsky et al., 1981, 1985) but A ‘moment arm analysis’ of the forces and moments their theories and calculations lack experimental veri- generated during lifting is shown in Fig. 1. The fication (Macintosh et al., 1987; McGill and Norman, 1988). McGill and colleagues (1988) have suggested that passive tissue involvement in heavy lifting is not essential and that, in practice, its contribution is small (Potvin et al., 1991). However, the predictions of their mathematical model depend greatly on an assumed function relating flexion angle and passive tissue mo- ment, and this has lead to some inconsistent results (Potvin et al., 1991). The objectives of the present study were to measure the passive extensor moment during everyday bending and lifting activities, and to indicate its likely origin. MATERIALSAND METHODS Experimental design Extensor moment generation was calibrated against EMG activity in the erector spinae muscles during a series of isometric pulls, each performed with a different amount of lumbar flexion. These calib- ISOMETRIC CALIBRATION rations showed how the passive component of exten- OF E.M.G. SIGNAL sor moment depended on lumbar flexion. Then, lum- bar flexion was measured continuously during dy- namic lifting activities, using the ‘3-Space Isotrak device, and the peak flexion angles used to calculate the passive extensor moment during each lift. A large- scale study was undertaken to overcome the random errors inherent in skin-surface EMG measurements. Subjects participating in the study intercept = I One hundred and forty nine healthy men and E.M.G. women volunteered for this study. None had any +, ACTIVITY history of severe low back pain. Most were nurses from Eo lmicrovolts) local hospitals, and had previously received some EM = W”D+w*dw = Eo*G+I training in how to lift. The other volunteers were white collar workers at the University and local hospitals. Fig. 1. Upper. A simple sagittal-plane model of forces and moments acting on the lumbar spine when the subject pulls Informed consent was obtained, but the objectives of upwards with force W. Lower. There is a linear relationship the study were not revealed and lifting technique was between extensor moment (EM) and EMG activity from the not discussed. Table 1 gives details of the subjects’ age, erector spinae muscles (Eo). Table 1. Details of the 149 subjects. ROF=range of flexion, and EM, =maximum extensor moment generated during the isometric pull Women (n = 126) Men (n = 23) Mean STD Range Mean STD Range Age (yr) 27.6 5.8 18-45 30.6 5.3 22-39 Bodymass (kg) 61.9 8.1 46.8-84.2 77.7 9.2 62.4-99.5 Height (cm) 165 6 150-183 179 I 167-193 Lumbar ROF (deg) 56.8 8.9 33.1-74.8 53.3 1.7 38.5-69.4 EM,,, (Nm) 245 51 145-383 430 116 212-640 Extensor moments during lifting 1079 assumptions underlying this model have been dis- During each pull, the curvature of the lumbar spine cussed previously (Dolan and Adams, 1993a). In static in the sagittal plane was measured at a frequency of equilibrium: 60 Hz using the 3-space Isotrak. The lever arms D and dw shown in Fig. 1 were estimated (Dolan and Adams, EM= WD+wdw, (1) 1993a) and input to the computer so that extensor where EM is the extensor moment, W, the vertical moment EM could be evaluated from the load cell force exerted on load cell and w, the weight of the data using equation (1). Extensor moment was then upper body and arms. D and dw are defined in Fig. 1. plotted against EMG activity (E,)as shown in Fig. 2. During an isometric contraction, EM is linearly (For ease of interpretation, every fifth data point was related to the EMG activity (E,) of the back muscles plotted so that the graph comprised of 40 points, (Dolan and Adams, 1993a) so that although all data were taken into account in sub- sequent analysis). Each subject performed between 6 EM=GEo+I, (2) and 12 calibrations with the lumbar spine ranging where G is the gradient of the graph and I is the between the slightly lordotic and fully flexed positions.
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